ACEC Indiana Associate Membership Application

ACEC Indiana Associate Membership Application
Firm Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website
Primary contact person for ACEC Communication*

First NameLast Name
Title*
Email*
example@example.com
Professional role in firm*
Other members to receive ACEC Indiana communications
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Minority status/special business classifications (check all that apply)

Certified Small BusinessMinority Business Enterprise (MBE)Women’s Business Enterprise (WBE)Disadvantages Business Enterprise (DBE)Service Disabled Veteran Owned Business (VBE)
Firm Description (Brief description of the firm's activities in 50 works or less)*
Services: Please indicate which services this firm provides (check all that apply)*

AsbestosAccountingAssociationCADD Services/ RenderingCommunity outreachContractor servicesData collection and AnalysisEcologye-PlanroomFoundation stabilizationGeotechnicalInsuranceLand surveyingLawPrinting, Plotting, ScanningLand surveyingProduct SuppliesRisk ManagementSoftwareStaffing/ EmploymentStrategic planningUnderwritingOther
Reasons for joining ACEC Indiana*

Networking OpportunitiesBusiness Practice ResourcesACEC National MembershipIndustry Insider InformationCommittee InvolvementOther
How did you hear about ACEC Indiana?*

Member in another stateOther
References (Including current ACEC Indiana member or similar)*

First NameLast Name
Email*
example@example.com
Membership Qualifications
Associate Member Firms shall be limited to those firms that do not furnish independent consulting engineering services and are not eligible for ACEC IN Member Firm membership and who support the strategic goals of ACEC IN. Firms must maintain an office in Indiana.

Associate Member Firms may participate in activities as set by ACEC IN policy including serving on all internal committees, but may not serve on liaison committees. ACEC IN Board of Directors provides for representation by one associate member, whom serves a three-year term.

Dues Information
- Affiliate membership dues are $600. Dues are assessed at the rate determined annually by the ACEC IN Board of Directors. Sponsorship opportunities are also available.
- Please send your payment along with this application, check payable to ACEC Indiana or online using a credit card.
- Contributions or gifts to ACEC IN are not deductible as charitable contributions for federal income tax purposes, but dues payments may be deductible as an ordinary and necessary business expense subject to restriction imposed as a result of association lobbying activities.
I have read the qualifications for membership above and believe this firm meets the requirements. I certify that the information I have submitted on this application is correct to the best of my knowledge. If this application is approved, I agree the firm will uphold the bylaws of ACEC IN and ACEC National.
Principal Name*

First NameLast Name
Title*
Signature*

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Date*

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ACEC Indiana Associate Membership Application

Other members to receive ACEC Indiana communications

Membership Qualifications